Placement Of Feeding Jejunostomy Research Articles

Comparison of laparoscopy versus mini-laparotomy for jejunostomy placement in patients with gastric adenocarcinoma.

Optimal nutrition is challenging for patients with gastric and gastroesophageal adenocarcinoma and often requires feeding tube placement prior to preoperative therapy. Feeding jejunostomy (FJ) placement via mini-laparotomy is technically easier to perform than laparoscopic FJ. The purpose of this study was to compare outcomes in patients with gastric adenocarcinoma undergoing laparoscopic versus mini-laparotomy FJ placement. A retrospective cohort study was performed of patients with gastric adenocarcinoma receiving laparoscopic versus mini-laparotomy FJ at a single tertiary referral center from 2000 to 2018. 30-day outcomes included complications, conversion to laparotomy, reoperation, length of stay, and readmission. A total of 656 patients met the inclusion criteria and were studied. The majority of patients were male (68.1%) with a mean age of 60.6years. The difference in surgical approach remained relatively stable over time. Overall, 82 (12.5%) patients experienced complications, and three (0.5%) patients died postoperatively. While readmission and conversion to open laparotomy did not differ between groups, overall complications (10.5% vs. 20.8%, p = 0.002), Clavien-Dindo ≥ 3 complications (4.0% vs. 8.9%, p = 0.021), length of stay (4.1 vs. 5.6days, p < 0.001), and reoperation (0.9% vs. 4.0%, p = 0.002) favored the laparoscopic over mini-laparotomy group. The current study helps clarify the risk of FJ placement in patients with gastric adenocarcinoma requiring nutritional support. Laparoscopic FJ placement has lower overall morbidity and length of stay compared to mini-laparotomy. However, caution is needed in preventing and identifying the rare causes of postoperative mortality that may be associated with laparoscopic FJ placement.

Corrosive injury of the upper gastrointestinal tract: the evolving role of a radiologist.

Corrosive injury is a devastating injury which carries significant morbidity. The upper gastrointestinal tract is predominantly affected with severity ranging from mild inflammation to full thickness necrosis which may result in perforation and death. Among the complications, stricture formation is most common, causing dysphagia and malnutrition. Endoscopy has a pivotal role in the diagnosis and management, with a few shortcomings. Imaging has an important role to play. Besides radiography, there is an increasing role of CT scan in the emergency setting with good accuracy in identifying patients who are likely to benefit from surgery. Further, CT scan has a role in the diagnosis of complications. Oral contrast studies help in assessing the severity and extent of stricture formation and associated fistulous complications in the subacute and chronic phase. The scope of intervention radiology for this condition is increasing. Fluoroscopy-guided balloon dilatation, drainage of collections or mucoceles, endovascular embolization of point bleeders, placement of feeding jejunostomy and image-guided biopsy are among the procedures that are being performed. Through this review we aim to stress the role the radiologist plays in the diagnosis and follow-up of these patients and in performing radiological interventions. Besides this, we have also highlighted few salient points to help understand the pathophysiology and management of such injuries which is paramount to ensure a good long-term outcome.

PTH-237 Differing risk of small bowel necrosis in patients undergoing oesophagectomy and total gastrfectomy with feeding jejunostomy placement: Abstract PTH-237 Table 1

Introduction Placement of feeding jejunostomy at the time of oesophagectomy or total gastrectomy has become standard of care at most UK centres. Review of the literature reveals isolated reports of small bowel necrosis, although the frequency of this problem is unclear. Further, it is unclear whether the risk of small bowel problems is similar for patients after gastrectomy as those after oesophagectomy. The aim of this study was to ascertain the frequency of small bowel problems in a cohort of patients undergoing oesophagogastric surgery. Method Retrospective review of patients undergoing oesophagogastric resection for cancer during the years 2009–2014. Results The study population comprised 325 patients undergoing oesophagogastric resection with jejunostomy placement (255 oesophagectomy, 70 total gastrectomy). Five patients undergoing total gastrectomy developed small bowel necrosis (5/70, 7%), while this was not observed in any patient undergoing oesophagectomy (0/255, 0%). The table details the time of this complication and the associated factors. All five patients developed small bowel necrosis after initial discharge from intensive care unit to the surgical ward. All patients required laparotomy with small bowel resection with double barrel stoma formation, parenteral nutrition and subsequent reconstruction (6–8 weeks later). Only one patient had a leukocytosis on the day of diagnosis. No laboratory abnormalities were identified in the preceding 24 hr in the other four patients. One patient dies from multi-organ failure, the remaining four were discharged home. Conclusion Small bowel necrosis and perforation is a serious and life threatening complication of feeding jejunostomy. In our cohort, it was observed exclusively in patients who had undergone total gastrectomy. There were very few antecedent signs of a problem. All patients required laparotomy and small bowel resection. Disclosure of interest None Declared.

Esophageal Foreign Body: Hooked Fishing Lure

2014 by The Society of Thoracic Surgeons Published by Elsevier be definitively identified during the endoscopy, and the object was retrieved (Fig 2A, B). An esophagram obtained immediately after endoscopic retrieval revealed significant pneumomediastinum and the presence of a leak. The patient was taken to the operating room for a left thoracotomy and exploration approximately 6 hours after the reported ingestion time. The location of the injury was identified, and the extent of contamination was found to be limited. Primary repair was performed with placement of feeding jejunostomy. The procedure was well tolerated, and the patient recovered uneventfully.

Laparoscopic procedures for small bowel disease

Small bowel procedures such as placement of feeding jejunostomy, diagnosis of small bowel ischaemia and obstruction, bowel resection and lysis of adhesions can all be performed laparoscopically. Diagnostic laparoscopy can be performed with low complication rates, and can help avoid unnecessary laparotomy. The open method of trocar placement is preferred in patients with adhesions or distended bowel due to obstruction or ileus. Feeding jejunostomy can be placed by laparoscopically assisted methods, pulling the jejunum out or completely laparoscopically. The latter requires fixation of the jejunum to the abdominal wall by transabdominal sutures or T-fasteners. The T-fastener technique for feeding jejunostomy is simple to perform, safe and effective. Small bowel ischaemia can be difficult to diagnose laparoscopically. Fluorescein and ultrasound Doppler examination of the small bowel may be as useful as in laparotomy, but there is little clinical experience with these techniques. Laparoscopically assisted small bowel resection involves intraperitoneal division of the mesenteric vessels and exteriorization of the small bowel through a small abdominal incision, followed by resection and anastomosis. The causes of small bowel obstruction can be diagnosed laparoscopically, and adhesions can be lysed under laparoscopic guidance. The laparoscopic approach is replacing laparotomy for many small bowel procedures. Improvements in instruments and experience in laparoscopic procedures will continue to make these procedures easier and safer to perform.

Risk of abdominal septic complications after feeding jejunostomy placement in patients undergoing splenectomy for trauma

Compared with total parenteral nutrition, enteral feeding via jejunostomy reduces septic complications in patients with severe trauma. However, violation of the bowel with insertion of a jejunostomy tube may increase the risk of intra-abdominal abscess (IAA), particularly if no simultaneous gastrointestinal tract injury exists. The records of 123 patients requiring splenectomy for trauma at a level I trauma center during a 6-year period (1986 to 1992) were reviewed to examine the incidence of IAA in patients with and without simultaneous jejunostomy placement in the presence and absence of gastrointestinal tract injuries. Thirty patients had jejunostomies placed (J), and 93 did not (NoJ). There were no significant differences between the groups in age, Abdominal Trauma Index, Injury Severity Score, or transfusion requirements. The incidence of IAA was not significantly different between the J and NoJ groups in the presence or absence of gastrointestinal tract injuries. Thus, jejunostomy placement does not increase the incidence of IAA after splenectomy regardless of the presence of a gastrointestinal tract injury.